The first line of medication treatment to reduce knee pain is usually NSAIDs, however, sometimes opioids are used. But are they worth their risk?
As we covered in previous articles, NSAIDs stand for Nonsteroidal anti-inflammatory drugs and are used to treat inflammation, pain, and swelling. These medicines can be bought at the drugstore, grocery store, and even at one of your local gas stations.
They are common, they are everywhere, and they are helpful.
However, though NSAIDs are effective, they can be problematic when taken for long periods of time or at high doses. Higher doses and time spent taking these medications can increase the risk of gastrointestinal bleeding, and ulcers, and even lend themselves to cardiovascular problems. NSAIDs can also cause fluid retention and kidney problems.
For people with knee osteoarthritis who can not achieve adequate pain relief from over-the-counter medicines, or can not take them for other reasons, sometimes the prescription drug tramadol is used.
Tramadol, which is sold under the brand names Ultram®, Ultracet, and Ultram® ER (extended-release), among others, is an opioid pain medicine that is sometimes used to treat moderate to moderately severe pain. Belonging to a class of opiate analgesics, tramadol is a narcotic that works by changing the way the brain and the nervous system respond to pain.
When it comes to relieving acute pain, prescription painkillers are sometimes used because they can relieve acute pain very effectively. The most common of these are morphine, codeine, and oxycodone, among several others- and they are primarily used in emergency and intensive care situations to induce anesthesia or reduce severe pain.
Though prescription painkillers like tramadol are sometimes used to treat osteoarthritis knee pain, recent studies have shown evidence that they don’t necessarily work better than NSAIDs do. Not only that but opioids like tramadol have been shown to lose their effectiveness with time.
Recently, The Cochrane Review shared the results of some extensive research regarding the benefits and harms of tramadol for treating osteoarthritis. They examined 22 studies involving 3871 people taking tramadol and 2625 people in a comparator group.
What they found overall, was that compared with a placebo, the evidence showed that taking tramadol for up to three months had no important benefit on pain or function. They also found that many people in the tramadol group experienced side effects that led them to stop taking it, such as nausea, vomiting, dizziness, constipation, tiredness, and headache.
Other studies have found that tramadol can be effective at relieving osteoarthritis pain in elderly sufferers, but, only when it is combined with acetaminophen ( Tylenol).
This makes one wonder if it’s the tramadol or the Tylenol that’s making the difference. In fact, a recent meta-analysis comparing NSAIDs and opioids for relief of knee osteoarthritis pain in over 5,500 patients found that on average, oral NSAIDs, less potent oral opioids (such as tramadol), and more potent oral opioids (such as oxycodone) all had similar efficacy and each reduced pain by about 30 percent.
There are also some studies that present evidence to support the claim that using opioids, such as tramadol to relieve osteoarthritis pain can actually make the condition worse. The problem is believed to be caused by the fact that opioids alter the perception of pain, but they do not do anything to help improve the symptoms of osteoarthritis.
Unlike NSAIDs, Tramadol doesn’t reduce inflammation and swelling, and it comes with its own set of side effects, ranging from nausea, vomiting, and dizziness, to addiction and even death.
Fortunately, most people do not need to take opioids for knee osteoarthritis, and most doctors will err on the side of caution when it comes to prescribing them. Though opioids, like tramadol, can be helpful in the short-term treatment of severe pain, in order to bridge the gap until a knee surgery or procedure can be performed- other than that, most find they are better off using NSAIDs for pain relief.
For those that wish to avoid taking medications as much as possible or who wish to focus on treating knee osteoarthritis directly, there are many other options. Not only can physical therapy and diet and lifestyle changes make a difference, but so can an invasive surgery such as a knee replacement, or a non-invasive procedure called Genticular Artery Embolization, which we specialize in here at MidAtlantic Vascular and Interventional.
The Bottom Line: Sometimes due to an inability to take NSAIDs due to gastrointestinal problems, cardiovascular risks, and kidney problems, a prescription opioid such as tramadol could be prescribed. However, even in these cases, the risks and potential problems that can come from using opioids may outweigh the benefits.
